Paradox Sports: The Spot ACI 2023

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We only accept ONE registration at a time. If you are registering for multiple people, please submit the first application and then refresh your page.

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Your Information

In order to complete your registration, please answer the questions below.

✓Contact Info

✓Medical Info

✓Climbing Info

✓Emergency Contact

✓Payment

Contact Information

First Name*

Last Name*

Address*

Address - apt or suite

City*

State*

Zip Code*

Email Address*

I'd like to receive updates from this organization

We will never share your email address. Ever.

Cell Phone*

Date of Birth*

Gender*

Are you a Veteran?*

Yes No

Is this your first Paradox Sports event?*

Yes No

How did you hear about this event?*

If you would like to be tagged in our Instagram or Facebook photos following the event, please let us know your social media handles here.

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Payment will be made on the final page.

Medical Information

Please select the category below that best describes your disability, or N/A if you do not have a disability.

Disability Category*

Choose one... Developmental Disability (autism, cerebral palsy, etc) Non-disabled Hearing Impairment / Deaf Lower Limb Difference / Amputation Neurological Disorder Other Paralysis PTSD Spinal Cord Injury Traumatic Brain Injury (TBI) Upper Limb Difference / Amputation Visual Impairment / Blindness

Please provide any details on your disability here:

Do you use a mobility device?

Will you be bringing a service animal?

Yes No

Do you have any serious allergies requiring EpiPen or other medication?*

Do you have any food allergies or dietary restrictions?*

Height:*

Weight (lbs):*

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Climbing Experience

Please elaborate on your climbing experience:

Climbing Details*

What are your goals for the Adaptive Climbing Summit?*

Describe any experience you have with adaptive sports / organizations:*

Do you need to borrow climbing gear for the event? If you need to borrow shoes, please include your shoe size.*

Are you a certified Single Pitch climbing guide?*

Yes No

Are you Climbing Wall Instructor (CWI) certified?*

No Selection No, I am not CWI certified. CWI Top Rope Certified CWI Lead Certified CWI Provider

Please list any other AMGA Certifications you have:*

If you work as a professional guide, please tell us where:*

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Payment will be made on the final page.

Emergency Contact

Emergency Contact - Full Name*

Emergency Contact - Relationship to you*

Emergency Contact - Phone Number*

Do you have any questions or concerns prior to attending?

Is there anything else you would like us to know?

Waiver of Liability

You will be required to sign the Paradox Sports waiver before participating on program. Please review and sign the trip waiver and media release attached to your course confirmation email.

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Payment will be made on the final page.

Complete Registration

Optional Donation

I would like to make a donation

$10
$25
$50
$75
$100
$

I’d like to cover the fees so 100% of my registration fee goes directly to Paradox Sports.

Payment Details

Payment Type:

Credit Card

eCheck

PayPal

Bank Account*

Name on Account*

Bank Routing Number*

Bank Account Number*

Card Number*

Security Code*

Expiration Month*

Expiration Year*

Name on Card*

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Submit Registration

Thank You!

Please check your email for a confirmation that your registration was received. If you do not receive a confirmation email, please contact us to verify.

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